Diagnosis of COVID-19 and the bariatric surgery population: a single center experience

Abstract

Background While many cases of the coronavirus disease 2019 are mild, patients with underlying medical conditions such as hypertension (HTN), diabetes mellitus (DM), older age, and morbid obesity are at higher risk of hospitalization and death. These conditions are characteristic of patients eligible for bariatric surgery, many of whom underwent weight loss procedures in the months prior to cessation of elective surgery in March 2020. The effects of the virus on these high-risk patients who had increased healthcare exposure in the early days of the pandemic are currently unknown. Objectives To describe the experience of patients who underwent bariatric surgery during the early evolution of the COVID-19 pandemic. Methods This is a cross-sectional study including patients from a single center who underwent bariatric surgery from January 1st, 2020 to March 18th, 2020. A database was created to analyze patients' demographics, operative variables, and postoperative outcomes. All patients were contacted and a telephone survey was completed to inquire about COVID-19 exposure, symptoms, and testing 30 days before and after surgery. Results A total of 190 patients underwent bariatric surgery during the study period. Laparoscopic sleeve gastrectomy was the most common procedure (71.6%). One hundred seventy-eight patients (93.7%) completed the telephone survey. Postoperatively, 19 patients (10.7%) reported COVID-19 compatible symptoms, and six patients (3.4%) went on to test positive for COVID-19. There were no COVID-19-related hospital admissions or mortalities in this population. Conclusions Morbidly obese patients are at high risk of severe disease secondary to COVID-19, and those undergoing bariatric surgery during the evolution of the pandemic reported symptoms at a rate of 10.7% 30 days after the surgery. While none of these patients suffered severe COVID-19 disease, the temporal relationship of their symptomatology and increased exposure to the healthcare system as a result of their surgery suggest an increased risk of disease with elective surgery.

Safety of Bariatric Surgery During the Opening Phase After the First Wave of the COVID-19 Pandemic: Experience at an Academic Center

“…No mortality was reported, and no need for an intermediate or ICU bed was required. These results are in accordance with previous studies that report overall complications rates between 1 and 6.8%, major complications between 1 and 2.4%, and mortality rates between 0 and 0.5% [ 13 – 15 , 20 ]. Combined, these results are in line with pre-pandemic reported outcomes, indicating the safety of bariatric surgery with morbidity and mortality rates of 5% or less and 0.1%, respectively [ 30 ].…”

“…Perioperative COVID-19 infection has negatively impacted the safety of patients undergoing surgery, increasing complications and mortality rates [ 1 , 4 ]. Currently, only a few studies have reported data on the risk of perioperative COVID-19 infection and safety outcomes in patients undergoing bariatric surgery during the ongoing pandemic [ 13 – 15 , 20 ]. One study reported 87 consecutive patients who underwent SG during the opening phase between the first and second COVID-19 waves [ 14 ].…”

“…Another study involving 300 consecutive patients reported no symptomatic COVID-19 infection during the first 30 days after surgery [ 15 ]. Another study that included 178 patients reported 3.4% of patients who tested positive for COVID-19 without COVID-19-related readmission or mortality [ 20 ]. Finally, in the most extensive study that included 2001 patients from different countries, symptomatic COVID-19 infection was reported in 0.5% ( n = 10) patients during the first 30 days after surgery [ 13 ].…”

The COVID-19 Pandemic Did Not Affect Target Weight Loss 1 Year Post Bariatric Surgery

“…There is limited data studying the effects of the pandemic in patients with complex multifactorial diseases such as obesity. We previously discussed the short-term exposure risk of an active bariatric cohort at the height of the COVID-19 pandemic [8]. However, the long-term effects of undergoing bariatric surgery at the time of a worldwide pandemic and its impact on the success of participation in the bariatric surgery program, from preparation for surgery through postoperative follow-up, are not well understood.…”

“…The impact of the COVID-19 pandemic on preoperative weight management, the infection risk, and perioperative outcomes of several bariatric cohorts have been discussed [8]. However, longer term data on the impact of the COVID-19 pandemic on weight loss after surgery is needed.…”